Drew Brees, the Purdue University quarterback legend who inspired a generation of young Tippecanoe County football players, says he won't let his three sons even think about playing tackle football until they are teenagers.

"At a certain age, I think it's appropriate," Brees told USA Today. "I think you can be too young to go out there and strap on a helmet."

President Barack Obama says if he had a son, he would "have to think long and hard before I let him play football."

After years of mounting evidence that professional football players can suffer debilitating brain damage as a result of multiple concussions suffered during their playing years, concern now is spreading at the high school and youth levels regarding the safety of America's beloved gridiron tradition.

Last week, the National Academy of Sciences issued an alarming report that found high school football players suffer concussions at nearly twice the rate of college players. The report also cited a lack of evidence that current sports helmets reduce concussion risk.

"The findings of our report justify the concerns about sports concussions in young people," said Robert Graham, chairman of the committee that authored the report. "However, there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."

That report followed on the heels of a recent HBO "Real Sports"/Marist Poll in which 33 percent of respondents said the link between head injuries in football and long-term brain trauma would make them less likely to allow their son to play football.

Such concerns may already be affecting lower levels of competition. According to USA Football, the national governing body for amateur football from high school on down, participation fell to 2.8 million youths last year from 3.1 million in 2011.

"Do I think in the near future we're in jeopardy of losing the sport? No, I don't," said East Tipp Little Gridiron President Ed Pearson, who played football at Harrison High School and Ball State University. "Do I think we're in jeopardy of losing some of the good athletes who choose to play baseball or basketball instead of going to football? Absolutely."

The Purdue Neurotrauma Group is in its fifth year of studying mild traumatic brain injury in order to develop improved methods of detection and prevention. In 2010, researchers made headlines with a study that detected brain injuries in high school football players who were not clinically diagnosed with concussions.

The group's stated goal is "to ensure that more youth may play more contact sports with less risk of long-term impairments." Eric Nauman, a Purdue engineering professor and one of the three principle investigators, said he would tell parents that football can be played safely — if certain conditions are met.

Two factors Nauman mentioned — equipment and diagnostic methods — are being pursued technologically by the Purdue Neurotrauma Group and other researchers. The third factor is one over which parents have complete control.

"You have to have a very good coach," said Nauman, who encourages parents to observe a team's coach prior to enrolling their child in the program. "If the choice is between playing for somebody who doesn't actually coach for a living and somebody who does, you have to go with the better coach — or just not play.

"I get so many emails from parents who want better helmets for their kids and send crazy reports of injuries at the 11-, 12-, 13-year-old level," Nauman continued. "If you have a coach like that, you're not really helping yourself. Good coaches teach really good technique — always have your hands up, never lead with your head, that kind of stuff."

The Indiana High School Athletic Association requires head coaches to either be certified teachers or complete two IHSAA-approved coaching courses. Yet at youth levels such as Little Gridiron, there is no mandatory certification, and parents of varying backgrounds volunteer to serve as coaches.

Little Gridiron officials say preventing head injuries is a priority. USA Football sponsors the "Heads Up" tackling program, which offers online tutorials about proper technique. The organization's website has a section on concussion awareness that discusses recognizing signs and symptoms and proper equipment fitting.

"Clearly it's on the parents' radar, and definitely on the school systems'," said Brad Alge, director of West Lafayette's Little Gridiron program, head coach of West Lafayette's eighth-grade team and a football parent. "All of the athletic leadership that I interact with, it's on everybody's conscience.

"What we see at the youth level is, parents want assurance. They want information. They want to know what we're doing as far as protecting their kids and trying to recognize potential signs if there are concussions. There's a lot more informed dialogue."

* * *

Lafayette resident Melissa Bridge, a nurse, has sent three sons through the East Tipp Little Gridiron program. She was already an anxious football parent before her oldest son, Conner, was forced to give up the sport due to concussion-related issues.

Her two youngest sons continue to play football, and Bridge puts her trust in the coaches and officials on the field to keep them safe.

"I think at this age that it boils down to the coaches and the referees, but I also think parents play a role in it," Bridge said. "It's education; it's how to tackle appropriately. I don't think a lot of times these (officials) — and we've gone to their meetings before — they've got to start calling it and then stop and teach the kids. That's what this is about, and they don't do that."

When asked if she still felt youth football was safe, Bridge said: "Absolutely, as long as they are being taught and as long as it is upheld by the coaches."

The IHSAA made concussions a point of emphasis for officials in the 2012 season, and coaches say that focus has carried forward. According to Lafayette resident and football referee Trent Johnson, a good official's responsibility doesn't stop at throwing penalty flags for dangerous hits or notifying coaches when they suspect a player may have sustained a concussion.

"We're talking to them: 'Hey, that was close. Make sure you see what you're tackling. Don't lead with the helmet,' " said Johnson, whose 25 years as a football official included an IHSAA state championship assignment in 2007. "From junior high all the way up until Friday night, we're constantly reminding kids: 'Head up, head up, head up.' "

At the professional level, much of the blame has shifted to overly aggressive players using helmeted heads as bone-crushing, ball-dislodging weapons. Some youth and high school coaches worry that young players will mimic NFL idols' incorrect tackling techniques.

Jason Bridge, Melissa's ex-husband and coach of their son Cooper's fourth- and fifth-grade Little Gridiron team, said he has pulled players out of practices or games for lowering their heads before contact. He said he struggles with how the game is policed, even though he doesn't see a sinister intent in most of those potentially dangerous incidents.

"I'm a fan of playing tackle football at this age, but what do most kids do when they come up and make a tackle? They close their eyes and lower their head," Jason Bridge said. "They don't intentionally use their head as a weapon. I believe they're just scared, which is where most injuries at this stage occur."

The National Academy of Sciences report pointed to another dimension of the problem: Young athletes face a "culture of resistance" when reporting possible concussions and complying with treatment plans.

"Despite increased knowledge about concussions ... there is still a culture among athletes and military personnel that resists both the self-reporting of concussions and compliance with appropriate concussion management plans," the report said. "In surveys, youth profess that the game and the team are more important than their individual health and that they may play through a concussion to avoid letting down their teammates, coaches, schools and parents."

* * *

Allowing a son to play football can be a difficult decision. Ask the Bridges.

Conner Bridge sustained four concussions in his Little Gridiron and junior high football career. According to Jason Bridge, two involved a loss of consciousness, and two resulted from improper hits by an opponent.

Conner was cleared by a doctor to return to the sport after each of three concussions. But after the fourth, a doctor informed the family that Conner could no longer play football and must be cleared medically before playing any contact sport.

Conner ran cross country this fall as a Harrison freshman and occasionally deals with post-concussion symptoms, such as headaches. His brothers, Cole and Cooper, played for WCJC (junior high) and Little Gridiron championships last week.

"Every parent's different," Jason Bridge said. "I have been chastised by a few people for letting him get back on the field after his third concussion. I respect that. In hindsight, knowing what I know now, we would have stopped."

One message that has filtered to the youth level is the concept that repeated small hits carry the same or greater risk than isolated big hits that result in concussions. Alge said the West Lafayette youth program has begun to cut down on the amount of hitting that occurs in practice.

According to the Centers for Disease Control, an estimated 173,285 sports-related traumatic brain injuries among people age 19 and younger are treated annually in emergency departments. The CDC says those numbers have increased by 60 percent in the past decade.

Football was cited as the most frequent cause of those TBIs, at 0.47 per 1,000 athlete exposures, followed by girls soccer, at 0.36. Soccer, basketball and bicycling were cited as the three most common activities for girls age 10-19 who sustained TBIs.

Football coaches often cite the same data when defending their sport, saying injuries — even brain injuries — can happen in nearly any activity.

"People ask me why I let my other two sons continue to play," Jason Bridge said. "Football is dangerous, and concussions can happen, but they can also happen from getting hit by a car while riding your bike. I'm not going to put them in a bubble. I just want them to be aware."

* * *

Every parent, athletic administrator and coach interviewed over the past month similarly pointed out that all contact sports carry risk, as do many other common activities. Alge said fewer than five West Lafayette Little Gridiron players were held out of games or practices due to concussions this season; two of the concussions were sustained in non-football injuries on the playground.

The same coaches who express concern about head injuries insist the rewards of football outweigh the risks.

"Every kid gets into a situation where they're not sure of themselves," Pearson said. "They come out the other side and go, 'Whoo, that's not as bad as I thought it would be.' For some it happens in third grade, and some it takes until sixth grade. Football really brings it out."

The findings of the Purdue Neurotrauma Group helped accelerate the national conversation on head injuries in football. It's possible their research has given pause to parents considering football for their child. Yet the researchers say their goal is not the end of football but rather the end of unsafe football, and parental awareness and choice is one step.

"Plenty of people will still be playing football," Nauman said. "There's something inherent in people, especially kids, about climbing and knocking people down. It's in the DNA, I think.

"I don't really worry about that. It's more likely that we'll see kids starting football later, and I don't think that's a bad thing."

Brees himself placed the responsibility for protecting players on parents, and said it starts with education.

"As a parent, you have to know what those risks are, and the protocols that have to take place when things happen," Brees said. "When you get a concussion, you should be out for a certain period of time. You should be taking the baseline test. You go back and take that test again, get cleared by medical professionals before you ever play. For a kid, it should be at least a week or two, if not more.

"... There are protocols in place, and they need to be followed, to a T. It's obviously very serious stuff."

In every helmet

This warning label appears on the inside of every football helmet manufactured by Schutt Sports, a major supplier of helmets to professional, college and high school teams.

WARNING

Scientists have not reached agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.

NO HELMET SYSTEM CAN PREVENT CONCUSSIONS OR ELIMINATE THE RISK OF SERIOUS HEAD OR NECK INJURIES WHILE PLAYING FOOTBALL.

Keep your head up. Do not butt, ram, spear or strike an opponent with any part of the helmet or faceguard. This is a violation of football rules and may cause you to suffer severe brain or neck injury, including paralysis or death and possible injury to your opponent. Contact in football may result in Concussion/Brain Injury which no helmet can prevent. Symptoms include loss of consciousness or memory, dizziness, headache, nausea or confusion. If you have symptoms, immediately stop and report them to your coach, trainer and parents. Do not return to a game or contact until all symptoms are gone and you receive medical clearance. Ignoring this warning may lead to another and more serious or fatal brain injury.

NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.